|
AMPUTATION OF TOE(P
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
761P1043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.02 |
| Max. Negotiated Rate |
$659.11 |
| Rate for Payer: Aetna Commercial |
$518.39
|
| Rate for Payer: Ambetter Exchange |
$168.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.02
|
| Rate for Payer: Anthem Medicaid |
$184.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.50
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$565.87
|
| Rate for Payer: Healthspan PPO |
$659.11
|
| Rate for Payer: Humana Medicaid |
$184.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$432.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$188.54
|
| Rate for Payer: Molina Healthcare Passport |
$184.84
|
| Rate for Payer: Multiplan PHCS |
$436.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.38
|
| Rate for Payer: UHCCP Medicaid |
$148.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$186.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.75
|
|
|
AMPUTATION - THIGH - THROUGH
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27590
|
| Hospital Charge Code |
76100879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
AMPUTATION - THIGH - THROUGH
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27590
|
| Hospital Charge Code |
76100879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
AMPUTATION - THIGH - THROUGH
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27590
|
| Hospital Charge Code |
76100879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.56 |
| Max. Negotiated Rate |
$1,320.72 |
| Rate for Payer: Aetna Commercial |
$1,233.51
|
| Rate for Payer: Ambetter Exchange |
$742.25
|
| Rate for Payer: Anthem Medicaid |
$588.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$742.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$742.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$890.70
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,320.72
|
| Rate for Payer: Healthspan PPO |
$1,117.30
|
| Rate for Payer: Humana Medicaid |
$588.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,054.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$742.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.33
|
| Rate for Payer: Molina Healthcare Passport |
$588.56
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$964.92
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$594.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$742.25
|
|
|
AMPUTATION - THIGH - THROUGH(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27590
|
| Hospital Charge Code |
761P0879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.56 |
| Max. Negotiated Rate |
$1,320.72 |
| Rate for Payer: Aetna Commercial |
$1,233.51
|
| Rate for Payer: Ambetter Exchange |
$742.25
|
| Rate for Payer: Anthem Medicaid |
$588.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$742.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$742.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$890.70
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,320.72
|
| Rate for Payer: Healthspan PPO |
$1,117.30
|
| Rate for Payer: Humana Medicaid |
$588.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,054.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$742.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.33
|
| Rate for Payer: Molina Healthcare Passport |
$588.56
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$964.92
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$594.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$742.25
|
|
|
AMPUTATION - TOE; INTERPHALAN
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
76101044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$710.95 |
| Rate for Payer: Aetna Commercial |
$584.73
|
| Rate for Payer: Ambetter Exchange |
$164.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.00
|
| Rate for Payer: Anthem Medicaid |
$166.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$164.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.51
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$466.89
|
| Rate for Payer: Healthspan PPO |
$710.95
|
| Rate for Payer: Humana Medicaid |
$166.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$506.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$164.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.50
|
| Rate for Payer: Molina Healthcare Passport |
$166.18
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$213.97
|
| Rate for Payer: UHCCP Medicaid |
$144.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$164.59
|
|
|
AMPUTATION - TOE; INTERPHALAN
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
76101044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$507.15
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
AMPUTATION - TOE; INTERPHALAN
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
76101044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.77 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$507.15
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
AMPUTATION - TOE; INTERPHALA(P
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
761P1044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$710.95 |
| Rate for Payer: Aetna Commercial |
$584.73
|
| Rate for Payer: Ambetter Exchange |
$164.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.00
|
| Rate for Payer: Anthem Medicaid |
$166.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$164.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.51
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$466.89
|
| Rate for Payer: Healthspan PPO |
$710.95
|
| Rate for Payer: Humana Medicaid |
$166.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$506.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$164.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.50
|
| Rate for Payer: Molina Healthcare Passport |
$166.18
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$213.97
|
| Rate for Payer: UHCCP Medicaid |
$144.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$164.59
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
AMPUT THIGH-FEMUR REAMP
|
Professional
|
Both
|
$7,561.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
76100881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.76 |
| Max. Negotiated Rate |
$4,536.60 |
| Rate for Payer: Aetna Commercial |
$1,093.70
|
| Rate for Payer: Ambetter Exchange |
$673.78
|
| Rate for Payer: Anthem Medicaid |
$514.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$673.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$673.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$808.54
|
| Rate for Payer: Cash Price |
$3,780.50
|
| Rate for Payer: Cash Price |
$3,780.50
|
| Rate for Payer: Cigna Commercial |
$1,182.65
|
| Rate for Payer: Healthspan PPO |
$990.65
|
| Rate for Payer: Humana Medicaid |
$514.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$931.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$673.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$673.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.06
|
| Rate for Payer: Molina Healthcare Passport |
$514.76
|
| Rate for Payer: Multiplan PHCS |
$4,536.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.91
|
| Rate for Payer: UHCCP Medicaid |
$2,646.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$673.78
|
|
|
AMPUT THIGH-FEMUR REAMP
|
Facility
|
IP
|
$7,561.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
76100881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,268.30 |
| Max. Negotiated Rate |
$7,258.56 |
| Rate for Payer: Aetna Commercial |
$5,821.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,897.58
|
| Rate for Payer: Cash Price |
$3,780.50
|
| Rate for Payer: Cigna Commercial |
$6,275.63
|
| Rate for Payer: First Health Commercial |
$7,182.95
|
| Rate for Payer: Humana Commercial |
$6,426.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,200.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,580.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,653.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,670.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,048.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,578.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,217.09
|
| Rate for Payer: PHCS Commercial |
$7,258.56
|
| Rate for Payer: United Healthcare All Payer |
$6,653.68
|
|
|
AMPUT THIGH-FEMUR REAMP
|
Facility
|
OP
|
$7,561.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
76100881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,268.30 |
| Max. Negotiated Rate |
$7,258.56 |
| Rate for Payer: Aetna Commercial |
$5,821.97
|
| Rate for Payer: Anthem Medicaid |
$2,600.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,897.58
|
| Rate for Payer: Cash Price |
$3,780.50
|
| Rate for Payer: Cigna Commercial |
$6,275.63
|
| Rate for Payer: First Health Commercial |
$7,182.95
|
| Rate for Payer: Humana Commercial |
$6,426.85
|
| Rate for Payer: Humana KY Medicaid |
$2,600.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,626.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,200.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,580.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,653.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,670.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,048.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,578.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,217.09
|
| Rate for Payer: PHCS Commercial |
$7,258.56
|
| Rate for Payer: United Healthcare All Payer |
$6,653.68
|
|
|
AMPUT THIGH-FEMUR REAMP(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
761P0881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.76 |
| Max. Negotiated Rate |
$1,182.65 |
| Rate for Payer: Aetna Commercial |
$1,093.70
|
| Rate for Payer: Ambetter Exchange |
$673.78
|
| Rate for Payer: Anthem Medicaid |
$514.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$673.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$673.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$808.54
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,182.65
|
| Rate for Payer: Healthspan PPO |
$990.65
|
| Rate for Payer: Humana Medicaid |
$514.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$931.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$673.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$673.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.06
|
| Rate for Payer: Molina Healthcare Passport |
$514.76
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.91
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$673.78
|
|
|
AMPUT THIGH-FEMUR REAMP(T
|
Facility
|
OP
|
$5,686.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
761T0881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,705.80 |
| Max. Negotiated Rate |
$5,458.56 |
| Rate for Payer: Aetna Commercial |
$4,378.22
|
| Rate for Payer: Anthem Medicaid |
$1,955.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,435.08
|
| Rate for Payer: Cash Price |
$2,843.00
|
| Rate for Payer: Cigna Commercial |
$4,719.38
|
| Rate for Payer: First Health Commercial |
$5,401.70
|
| Rate for Payer: Humana Commercial |
$4,833.10
|
| Rate for Payer: Humana KY Medicaid |
$1,955.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,975.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,662.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,196.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,705.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,994.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,003.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,264.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,548.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,946.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,923.34
|
| Rate for Payer: PHCS Commercial |
$5,458.56
|
| Rate for Payer: United Healthcare All Payer |
$5,003.68
|
|
|
AMPUT THIGH-FEMUR REAMP(T
|
Facility
|
IP
|
$5,686.00
|
|
|
Service Code
|
HCPCS 27596
|
| Hospital Charge Code |
761T0881
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,705.80 |
| Max. Negotiated Rate |
$5,458.56 |
| Rate for Payer: Aetna Commercial |
$4,378.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,435.08
|
| Rate for Payer: Cash Price |
$2,843.00
|
| Rate for Payer: Cigna Commercial |
$4,719.38
|
| Rate for Payer: First Health Commercial |
$5,401.70
|
| Rate for Payer: Humana Commercial |
$4,833.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,662.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,196.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,705.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,003.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,264.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,548.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,946.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,923.34
|
| Rate for Payer: PHCS Commercial |
$5,458.56
|
| Rate for Payer: United Healthcare All Payer |
$5,003.68
|
|
|
AMVIA EDGE DR-T
|
Facility
|
IP
|
$17,202.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,160.60 |
| Max. Negotiated Rate |
$16,513.92 |
| Rate for Payer: Aetna Commercial |
$13,245.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,417.56
|
| Rate for Payer: Cash Price |
$8,601.00
|
| Rate for Payer: Cigna Commercial |
$14,277.66
|
| Rate for Payer: First Health Commercial |
$16,341.90
|
| Rate for Payer: Humana Commercial |
$14,621.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,105.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,695.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,160.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,137.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,901.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,761.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,965.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,869.38
|
| Rate for Payer: PHCS Commercial |
$16,513.92
|
| Rate for Payer: United Healthcare All Payer |
$15,137.76
|
|
|
AMVIA EDGE DR-T
|
Facility
|
OP
|
$17,202.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,160.60 |
| Max. Negotiated Rate |
$16,513.92 |
| Rate for Payer: Aetna Commercial |
$13,245.54
|
| Rate for Payer: Anthem Medicaid |
$5,915.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,417.56
|
| Rate for Payer: Cash Price |
$8,601.00
|
| Rate for Payer: Cigna Commercial |
$14,277.66
|
| Rate for Payer: First Health Commercial |
$16,341.90
|
| Rate for Payer: Humana Commercial |
$14,621.70
|
| Rate for Payer: Humana KY Medicaid |
$5,915.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,975.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,105.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,695.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,160.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,034.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,137.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,901.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,761.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,965.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,869.38
|
| Rate for Payer: PHCS Commercial |
$16,513.92
|
| Rate for Payer: United Healthcare All Payer |
$15,137.76
|
|
|
AMVISC 1.2% SYR 9.6MG/0.8ML
|
Facility
|
OP
|
$561.56
|
|
|
Service Code
|
NDC 57770049565
|
| Hospital Charge Code |
25003825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$168.47 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Aetna Commercial |
$432.40
|
| Rate for Payer: Anthem Medicaid |
$193.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.02
|
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: Cigna Commercial |
$466.09
|
| Rate for Payer: First Health Commercial |
$533.48
|
| Rate for Payer: Humana Commercial |
$477.33
|
| Rate for Payer: Humana KY Medicaid |
$193.12
|
| Rate for Payer: Kentucky WC Medicaid |
$195.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.17
|
| Rate for Payer: Ohio Health Group HMO |
$421.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.48
|
| Rate for Payer: PHCS Commercial |
$539.10
|
| Rate for Payer: United Healthcare All Payer |
$494.17
|
|
|
AMVISC 1.2% SYR 9.6MG/0.8ML
|
Facility
|
IP
|
$561.56
|
|
|
Service Code
|
NDC 57770049565
|
| Hospital Charge Code |
25003825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$168.47 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Aetna Commercial |
$432.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.02
|
| Rate for Payer: Cash Price |
$280.78
|
| Rate for Payer: Cigna Commercial |
$466.09
|
| Rate for Payer: First Health Commercial |
$533.48
|
| Rate for Payer: Humana Commercial |
$477.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.17
|
| Rate for Payer: Ohio Health Group HMO |
$421.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.48
|
| Rate for Payer: PHCS Commercial |
$539.10
|
| Rate for Payer: United Healthcare All Payer |
$494.17
|
|
|
AMYLASE
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
30000238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
AMYLASE
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
30000238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$6.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.48
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$6.48
|
| Rate for Payer: Humana Medicare Advantage |
$6.48
|
| Rate for Payer: Kentucky WC Medicaid |
$6.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
ANA ANTI NUCLEAR ANTIBODY IFA
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
30000975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$12.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.09
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$12.09
|
| Rate for Payer: Humana Medicare Advantage |
$12.09
|
| Rate for Payer: Kentucky WC Medicaid |
$12.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
ANA ANTI NUCLEAR ANTIBODY IFA
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
30000975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
